Provider Demographics
NPI:1619959343
Name:HIRSCH, KELLY J (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 N MAIN ST
Mailing Address - Street 2:PO BOX 627
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1226
Mailing Address - Country:US
Mailing Address - Phone:607-758-8019
Mailing Address - Fax:607-758-8210
Practice Address - Street 1:4077 WEST RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1637
Practice Address - Country:US
Practice Address - Phone:607-753-9977
Practice Address - Fax:607-753-7311
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334759363LF0000X
NYF381523 1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000926203001OtherHEALTHNOW
NY02597780Medicaid
161010811OtherCOMMERCIAL CARRIERS